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Phase II study of border zone stereotactic radiosurgery with bevacizumab in patients with recurrent or progressive glioblastoma multiforme

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Abstract

Purpose

Recurrent glioblastoma is universally fatal with limited effective treatment options. The aim of this phase 2 study of Border Zone SRS plus bevacizumab was to evaluate OS in patients with recurrent GBM.

Methods

Patients with histologically confirmed GBM with recurrent disease who had received prior first-line treatment with fractionated radiotherapy and chemotherapy and eligible for SRS were enrolled. Bevacizumab 10 mg/kg was given day -1, day 14, and then every 14 days until disease progression. 1–14 days before BZ-SRS procedure, patients underwent brain MRI /MRS. MRS with measurement of choline-to-N-acetyl aspartate index (CNI) area ≥ 3 was targeted for SRS.

Results

From 2015–2017, sixteen of planned 40 patients were enrolled. The median age was 62 (range, 48–74Y). 3/16 (0.188) participants experienced grade 2 toxicity. No AREs were reported. The mOS was 11.73 months compared to 8.74 months (P = 0.324) from date of SRS for the BZ-SRS and institutional historical controls, respectively. PFS-6 and OS-6 were 31.2% (p = 0.00294) and 81.2%(p = 0.058), respectively. Of 13 evaluable for best response: 1 CR (p = 0.077), 4 PR (p = 0.308), 7 SD (p = 0.538), and 1 PD (p = 0.077). 11/16 participants had MRS scans with an estimated probability that MRS changes a treatment plan of 0 (0, 0.285).

Conclusion

BZ-SRS with bevacizumab was feasible and well tolerated. There is no significant survival benefit using BZ-SRS with bevacizumab compared to institutional historical controls. Secondary analysis revealed a trend toward improved PFS-6, but not OS-6 after BZ-SRS. MRS scans did not result in changes to SRS treatment plans.

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Data availability

All data supporting the findings of this study are available within the paper and its Supplementary Information. The experimental data and results that support the findings of this study are available at https://www.clinicaltrials.gov/study/NCT02120287.

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Funding

This clinical trial was funded by a grant to Dr. Ajay Niranjan from Genentech and International Radiosurgery Research Foundation. This research received no other specific grant from any funding agency in the public, commercial, or not-for-profit sector.

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Authors and Affiliations

  1. University of Pittsburgh Medical Center, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA

    Megan Mantica, Jan Drappatz & Frank Lieberman

  2. University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Constantinos G. Hadjipanayis, L. Dade Lunsford & Ajay Niranjan

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  1. Megan Mantica
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Contributions

Study design: AN, DM, JD, DL. Acquisition of data: AN, FSL, JD, DL. Statistical analysis: DM. Interpretation of the data: MM, AN, DM, JD, DL, CH. Drafting of the initial manuscript: MM, AN, DM, JD, DL, CH. Review and revision of the manuscript: all authors. Approval of the final manuscript: all authors.

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Correspondence to Megan Mantica.

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This clinical trial was funded by a grant to Dr. Ajay Niranjan from Genentech and International Radiosurgery Research Foundation.

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Mantica, M., Drappatz, J., Lieberman, F. et al. Phase II study of border zone stereotactic radiosurgery with bevacizumab in patients with recurrent or progressive glioblastoma multiforme. J Neurooncol 164, 179–190 (2023). https://doi.org/10.1007/s11060-023-04398-0

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